US senator probes Ascension, alleging it operates 'like a private equity fund'

Sen. Tammy Baldwin of Wisconsin is probing St. Louis-based Ascension — which operates 33 facilities in her state — alleging the health system is acting on private, not public, interests. 

Ms. Baldwin penned a letter to Ascension's CEO, Joseph Impicchice, on Feb. 13, demanding a written response to eight questions regarding the health system's investment activities. The letter was inspired by recent local reporting that illuminated long wait times, surgery delays and staff concerns about patient safety at Ascension Columbia St. Mary's, and the closure of a labor and delivery unit at Ascension St. Francis, both in Milwaukee. 

"Ascension and its physicians, nurses and caregivers are proud of our mission to provide care for those most vulnerable — especially during the past three years of the COVID pandemic — and we look forward to continuing to work with Senator Baldwin on ways to serve the community," the health system told Becker's in a statement. 

As a nonprofit, tax-exempt health system, Ascension is required to serve public interests and benefit the communities it serves. However, Ms. Baldwin wrote she is "concerned that the opposite is occurring — that by operating like a private equity fund, Ascension is squeezing staff, closing facilities, and extracting cash from its member hospitals for dubious 'management fees' all to advance its investment activities and provide compensation to its executives." 

Ascension Capital, the health system's "strategic investment initiative," lost more than $750 million in the most recent financial quarter, which is around $200 million more than Ascension put toward charity care in the same time span, according to Ms. Baldwin. 

"At this year's J.P. Morgan Healthcare Conference, your CFO Elizabeth Foshage highlighted Ascension's $18 billion of cash and investments," Ms. Baldwin wrote. "This number raises questions about why Ascension, a mission-driven health system with non-profit status, is not prioritizing reinvestment into serving vulnerable communities and its own operations — which should include increasing pay and improving working conditions for its burned out and overextended health care workforce."

Ms. Baldwin noted that she is not the first to question Ascension's investment activities. During a 2018 investigation into the closure of Washington, D.C.-based Providence Hospital, the D.C. attorney general's office found that the health system charged the hospital excessive fees for services provided by companies in Ascension's private equity portfolio. And a 2021 STAT investigation revealed investments that do not seem to align with the health system's strategic mission, such as a partnership with revenue cycle management company R1 RCM.

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